We the People Health Care Symposium
May 1, 2013
Good morning. Thank you, Cástulo, for that introduction. And thank you, Monica and Hector, for your leadership at ImpreMedia and the Latino Coalition, respectively, and for your partnership in hosting this important summit. It’s a pleasure to be here with you today.
I’d like to begin today by traveling back three years to the health care system that was in place before the President signed the Affordable Care Act.
For Americans who had insurance, premiums were rising three times faster than wages. Some people hadn’t seen a raise in years because every extra dollar of compensation went to paying their insurance premium. And many health plans had such meager benefits that they offered almost no security at all. More than 60 percent of bankruptcies before the law passed were related to medical bills, and more than three quarters of those people HAD insurance.
And the people with health coverage were the lucky ones. Another 50 million Americans, more than a third of them Latino, were locked or priced out of the system altogether. That forced far too many of our family members, friends, and neighbors into making impossible choices. It meant mothers lying awake at night hoping the lump in their breast would go away on its own. It meant fathers swallowing a handful of aspirin every morning because they couldn’t afford a trip to the doctor. It meant hardworking people living every day with the burden of knowing that if they or a loved one got sick, they could lose everything they’d worked for.
And the system was just as broken for American businesses. Those same rising premiums that took a toll on Americans’ household budgets cut into the balance sheets of businesses too. Health care represented an uncontrollable cost that made it hard for them to plan ahead. Small businesses had it especially bad.
Because they lacked the leverage necessary to drive down rates, small businesses paid an average of 18 percent more than larger companies for similar coverage. And premiums could skyrocket across the board if one employee developed a serious illness. The result was that the share of small businesses offering health coverage fell steadily in the decade before the Affordable Care Act passed.
So this is where we came from: a system that was broken for families and business with all the trend lines moving in the wrong direction.
Over the last three years, the Affordable Care Act has put our system on a better track by making improvements in two key areas.
The first is health care delivery. Under the old system, the incentives were backwards. Providers were rewarded for delivering unnecessary and duplicative care, while those who kept patients healthy and out of the hospital were actually punished financially. This drove up costs across the system.
So the first part of the law is an historic set of reforms designed to change those incentives to reward the higher quality, lower cost care we’ve seen work in leading health systems across the country.
And we’re already seeing some promising results. Central line bloodstream infections—one of the most common kinds of medical errors—are down more than 40 percent nationally since 2008. Hospital readmissions in Medicare have fallen dramatically in the past year, resulting in an estimated 70,000 fewer patients returning to the hospital with dangerous and costly complications. And most promising of all, growth in national health care spending has fallen to a 50-year low.
The reforms in the law are just starting to take effect, and more work remains to be done to move us from a health care system based on volume to one based on value. But for the first time in many years, we are clearly moving in the right direction. The private sector has begun to adopt some of the innovative models we’re testing in Medicare and Medicaid. And we’re incorporating lessons from the private insurance industry back into these models as well. A transformation has been set in motion. And as more of these reforms kick in, we’re going to see the health care system continue to evolve, slowing the growth of costs across the system.
But that’s only part of the job of fixing American health care. If we want to have a health care system that’s worthy of the greatest nation on earth, we also need to make sure that all Americans can access that system. And that’s what I want to focus on today.
The law has already taken some important steps to help Americans get the care they need. More than three million young adults have gained coverage under their parents’ health plans—including over 900,000 Latino young adults. More than 100 million Americans can now get cancer screenings and other essential preventive care without spending a dollar out of pocket. More than six million seniors have saved an average of $706 each on their prescription drugs, enough to cover a few months of groceries. And greater scrutiny of premiums has led to a 30 percent drop in the average premium hike for Americans who buy their own coverage.
Starting this fall, even more families will benefit when the health care law expands access to coverage for millions of Americans in two ways: through new Health Insurance Marketplaces in every state, and through the expansion of many state Medicaid programs as well. For the one in three Latinos who are currently uninsured, this may be a lifeline.
When the new Marketplaces open for enrollment this October—and I want to be clear: every state will have a Marketplace—they will give families and small business owners a whole new way to find coverage that fits their budget.
For families, these new Marketplaces will mean you’ll actually be able to easily see and compare premiums and deductibles before you enroll. Discrimination against pre-existing conditions will be banned. Every plan will have to offer a minimum package of benefits that we know everyone needs, including doctor visits, preventive care, hospital visits, and prescriptions. And for many, there will be tax credits that will give people an immediate break on the costs of insurance.
What this will do is create competition in the health insurance market that will actually benefit consumers. Instead of competing to sign up the healthiest people or to sell plans with the skimpiest benefits or densest fine print, insurers will compete to offer the best coverage at the lowest price. And while the Marketplaces don’t open until this October, we’re already seeing evidence that insurers are looking at innovative ways to keep costs down.
These new Marketplaces will also create a better market for small business owners through the Small Business Health Options Program, or SHOP.
Hundreds of thousands of small business owners are already seeing savings thanks to new tax credits in the law. And in 2014, the SHOP will bring additional benefits for small business owners.
It will allow them to pool their purchasing power, which will help them get lower premiums like big businesses, and ensure that premiums won’t skyrocket when a single employee develops a serious illness. The SHOP will also make it easier to pick the right plan by allowing business owners and their agents and brokers to easily compare premiums, deductibles, and benefit packages before they enroll. And under the rule we’ve proposed, beginning either next year or in 2015, depending on your state, the SHOP will let small businesses offer their employees a range of plans just like larger employers do, while still receiving a single bill and writing a single check.
What this all adds up to is a huge opportunity for families and business owners to seize better coverage options. But it’s still just an opportunity—we need your help to make it a reality.
That starts with reaching out to your colleagues in the business community. Mid-size and larger employers can help educate the smaller businesses in your community. And everyone can help clear up a lot of the misinformation that’s out there.
The Small Business Administration has made some great resources available to help you do that. And you can find all of that information by visiting SBA.Gov.
But you also have a stake in this law that goes beyond your own company’s insurance bill.
As Americans, we’re all better off when workers can be more productive because they aren’t held back by untreated chronic illnesses. We’re all better off when young entrepreneurs can pursue their dreams without worrying about losing their health coverage. We’re all better off when our insurance bills aren’t inflated by tens of billions of dollars in uncompensated care for the uninsured. The healthier your customers, employees, and cities are, the more successful your business will be and the more successful our country will be.
So today, I’m also asking you to be leaders in getting uninsured Americans signed up for coverage. We know the benefits of health coverage can be enormous, both for people’s health and for their financial security. But we also know that a lot of people may not be aware of the new options available to them.
About two fifths of all uninsured adults today are between the ages of 18 and 35, and more than a quarter of them are Latino. If you have children in their twenties like I do, you know that getting health insurance is not always the first priority for this demographic. I don’t know what their first priority is, but it certainly isn’t insurance.
There are other people out there who have spent so many years getting jerked around by insurance companies they’ve come to believe that affordable insurance will never be within reach.
Others may face language barriers, including nearly four million people whose primary language is Spanish.
How effectively we can reach these people is going to determine how many people this law helps and how big an impact it makes on our communities. And we’re going to need your help.
One of the most effective resources you can use right now is HealthCare.gov, which is offered in English and Spanish. People can sign up right now for e-mails and text messages that will help prepare them for enrollment this fall. You can sign up too, and get helpful information you can share with your network of family, friends, and co-workers. Thanks to the terrific work being done by ImpreMedia and Latino Decisions, we know that Latino families are craving more information about the law and what it means for them.
A lot of these people might not be listening to people from Washington like me—but they will listen to trusted community leaders like you. The survey results you’ll discuss today reiterate what we know to be true for the Latino community: they want their information from trusted sources. So especially as we get closer to October 1st, when the Marketplaces open for enrollment, we are going to need your help to spread the word.
And I hope that, as business and community leaders, you will also make your voices heard on the issue of Medicaid expansion. We know that health insurance improves health and saves lives. But that’s not the only reason to be in favor of expanding Medicaid.
Medicaid expansion also ensures that doctors and hospitals get paid. It reduces the burden of uncompensated care. It injects significant resources into your local economies. And the best part of the deal is that the federal government will cover 100% of the costs of Medicaid expansion for the next three years, and at least 90% after that.
I’ve been a Governor, and I know that states are never going to get a better deal for the health of their people or their economies. And as business leaders, it’s critical that you add your voices to this conversation.
When you look at our health care system today compared to where we were three years ago, it’s clear that the law is working. Tens of millions of Americans are already benefitting from the law, and those trend lines that were all pointing in the wrong direction have started to turn around.
Fulfilling the full promise of this law isn’t going to be easy. The easy thing to do would have been to do what we did for the last fifty years: just sit back and do nothing as costs continued to skyrocket and tens of millions of Americans continued to be locked out of the system.
Taking these problems on is the harder path. But just because it’s hard doesn’t mean it’s not worth doing. It’s hard to shift a care delivery system that has been organized for decades around paying for quantity to one around paying for quality. But it’s worth doing. It’s hard to slow the rise of health care costs that have been rapidly increasing for decades. But it’s worth doing. It’s hard to create an insurance market that puts coverage in reach for millions of uninsured and underinsured Americans, no matter if we lose our job, retire early, get sick, or are born with a disability. But it’s worth doing.
We’ve got a lot of work left to do, but we are on the right track. And with your help, we can fulfill the promise of this law and build the health care system Americans deserve.